An estimated 700,000 people in the U.S. suffer a stroke each year with an estimated 85% experiencing partial paralysis on one side of the body. Stroke is the third-leading cause of death in the U.S. The annual costs of care for stroke victims are staggering, amounting to about $35 billion per year.
The National Institute of Health defines a stroke as an interruption of the blood supply to any part of the brain. A stroke is sometimes called a “brain attack.” There are two types of stroke. An ischemic stroke occurs when a blood vessel carrying blood to the brain is blocked by a blood clot. A hemorrhagic stroke is when a blood vessel breaks open, causing blood to leak into the brain.
As with other medical problems such as heart attacks, speed is of the essence when someone experiences symptoms of a stroke. Dr. Chelsea Grow, a neurologist with Memorial Neurosciences who practices at Memorial Hospital at Gulfport, said it is important to get care within three hours of experiencing neurological symptoms such as weakness on one side of body, difficulty of speech and visual field loss.
“Get to the emergency room as soon as possible for thrombolytic therapy with tPA (tissue plasminogen activator),” Grow said. “This is basically a clot buster-type of drug that would break up the clot blocking the blood flow to a particular part of the brain. It saves the area at risk of further irreversible nerve cell death. By breaking up the clot, it saves those nerve cells from being irreversibly damaged. This is used only within three hour of the onset of ischemic stoke. People with hemorrhagic stroke, which is a bleeding stroke, are not candidates for tPA therapy.”
Grow said even a minute outside the three hours and the benefits of tPA are outweighed by the risks. That is why it is important to seek medical attention quickly.
A new development which is not yet the standard of care is called intraarterial tPA. Within a six-hour window, an angiogram is used to identify where the clot is, and a catheter infuses medication directly at the site of the obstruction.
Some hospitals, mostly academic centers, use intraarterial tPA now.
“It is being used now in certain areas,” she said. “It is more localized. You are getting right at the site of the obstruction where the problem is. The studies have not yet proven it is a better outcome. That is why it is not standard of care yet.”
Another promising area that also isn’t yet standard of care is TMS, which stands for transcranial magnetic stimulation. TMS is a way to stimulate the motor cortex of the brain, and studies have shown patients receiving TMS tend to do better in terms of functional recovery of the affected limb that had weakness.
“They are not sure exactly why it works, but it may be stimulating the damaged motor cortex and cortical plasticity, meaning areas of nerves of brain cells surrounding damaged area, to take over function for damaged cells,” Grow said. “There is a potential role for that in the acute phase of therapy to regain function. That is something new that has good potential.”
One complication of stroke can be spasticity. Grow said currently injections of Botox can be used successful to relieve the spasms and get pain relief. Sometimes it also results in functional improvement.
“We are doing that pretty commonly,” Grow said. “It is an off-label use of the drug, but it helps dramatically.”
Another new development for stroke patient therapy is on the way to the North Mississippi Medical Center (NMMC). Cheri Nipp, occupational therapist and coordinator for outpatient rehabilitation services at NMMC, said the hospital is getting a neuroprosthetic device in January called the Ness H200 produced by Bioness Inc. (www.bioness.com).
The device is a glove that sends an electrical pulse to re-educate the damaged limb to regain function.
“I have talked with four facilities across the U.S. that are seeing great results,” Nipp said. “The Shepherd Center in Atlanta has probably been one of the earlier facilities to begin the use of it. They are seeing good results in patients being able to gain more use of that arm.”
Initially the device will be used for patients undergoing therapy at the rehabilitation center. But Nipp said if it is appropriate, they want patients to be able to purchase the device and be able to use it in their lives.
Bioness also has a similar device for lower extremities, the L300, that was just recently approved by the FDA.
“We are also about to get that device in January, and will be one of 10 facilities in the nation that will have the L300,” Nipp said. “A lot of facilities are starting to use the H200, but the L300 is brand new. We definitely are always looking for what we can bring to Mississippi. We have people driving to Tennessee and Alabama to try to find the latest. We are excited we can bring some new technology to North Mississippi.”
Another stroke treatment advance Nipp believes is promising doesn’t involve technology. It is called constraint induced movement therapy (CIMT). A lot of research is being done on the techniques that constrain the part of the body not affected while work to train a different part of the brain to take on the responsibilities that were affected by the stroke.
“That has been around for a while, but it is being studied a lot more,” Nipp said. “It has been found to work better with children who have suffered some sort of brain injury because children’s brains are still developing. But they are trying to see how it will work on adults. We have had one patient who has gone to the University of Alabama Birmingham, which has been studying this as part of their program. We have not yet implemented a program with that modality.”
Contact MBJ contributing writer Becky Gillette at firstname.lastname@example.org.